理想的には、患者ケアにかかわる決断はエビデンス総体（body of evidence）によるべきで、そのエビデンスの確実性評価ツールがGRADEシステムです。そして、個々の研究（individual studies）の結果が信頼できるものかを評価する際にも、GRADEドメインを活用できるだろうという主張の論文です。

Are these results trustworthy? A guide for reading the medical literature
Avicenna J Med. 2017 Apr-Jun;7(2):46-50

Physicians practicing evidence‑based medicine need to be able to appraise a new study and determine whether the results warrant sufficient certainty to the level that they can be applied to patient care. Without such appraisal, misleading results can be incorporated into patient care, which can lead to inefficient, costly, and possibly harmful care. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach offers a modern framework that can be applied to evaluate the trustworthiness of evidence. In this guide, we present a simplified approach based on GRADE; in which we call on readers of the medical literature to pay attention to six domains before making an overall judgment about the trustworthiness of results and before applying the evidence to patient care

GRADEアプローチとして、６つのドメインが記載されていますが、５つのグレードダウンと1つのグレードアップ（３要因）です。